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The pincer-nail deformity is characterized by an excessively curved and distorted nail across the
transverse dimension. Forty-nine sides (paronychial folds) were dissected off the distal phalanx
periosteum with scissors and/or a small elevator. The dermis was placed between the paronychial
fold and the plalanx to flatten the germinal and sterile matrix. Direct comparison of autograft
dermis to homograft dermis did not show any significant differences in postcorrection appearance
of the nail or relief of symptoms. Surgical time averaged 22 minutes less in those patients having
reconstruction on both sides of one nail with homograft dermis. (J Hand Surg 2005;30A:400 403.
Copyright 2005 by the American Society for Surgery of the Hand.)
Key words: Pincer, dermal homograft (Alloderm), trumpet, nail.
From the Southern Illinois University School of Medicine, Plastic Surgery Institute, and Southern Illinois University, Springfield Surgical
Associates, Springfield, IL.
Received April 16, 2004; accepted in revised form September 23,
2004.
No benefits in any form have been received or will be received from
a commercial party related directly or indirectly to the subject of this
article.
Reprint requests: Dr Elvin G. Zook, Southern Illinois University,
School of Medicine, PO Box 19653, Springfield, IL 62794-9653.
Copyright 2005 by the American Society for Surgery of the Hand
0363-5023/05/30A02-0025$30.00/0
doi:10.1016/j.jhsa.2004.09.005
Technique
400
401
Figure 7. Application of reinforced silicone sheeting to protect nail bed after surgery.
Figure 4. Elevation of the nail bed off the distal phalanx with
creation of a tunnel for the graft.
402
Homologous
Dermis
Autologous
Dermis
Total
18
12
30
15
4
19
33
16
49
Figure 8. The corrected nail (left) and uninvolved nail (dorsal) and end-on view of patient in Figure 1.
Discussion
A total of 20 patients had nail reconstruction on 25
digits including 4 toes, 11 thumbs, 6 long fingers, 3
ring fingers, and 1 small finger. (Seventeen digits
were idiopathic and 8 had presumed traumatic
sources of the pincer-nail deformity) (Tables 1, 2).
Fifty-two percent of the pincer-nail deformities were
painful before surgery. All patients evaluated had
Figure 9. (A) Presurgical pincer nail with deformity and pain. (B) Postsurgical correction with allografts (Alloderm).
403
Cause
Digit
Technique
Pain
(Pre/Post)
1
2
3
T
T
T
T
T
T
T
T
I
I
I
I
I
I
I
I
I
I
I
I
I
I
Th
R
R
L
Th
Toe
Toe
L
Toe
L
L
Th
Th
L
L
S
Th
Th
Th
Toe
Th
Th
Th (one
side)
Th
R
A
H
H
H
H
H
A
H
H
H
H
H
A
H
H
H
H
H
A
A
A
A
N/N
Y/N
Y/N
Y/N
N/N
Y/N
N/N
Y/N
Y/N
N/N
N/N
Y/N
Y/N
Y/N
N/N
N/N
Y/N
Y/N
Y/N
N/N
N/N
Y/N
A
A
A
N/N
N/N
N/N
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
I
I
I
OR Time
Correction
Complications
1:35
1:07
1:15
1:40
1:20
1:20
1:19
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
1112
15
153
153
230
169
927
195
195
253
253
86
1131
165
279
279
363
157
221
331
14
811
N
N
N
N
N
N
N
N
N
Small nonadherence
N
N
N
N
N
N
N
N
N
N
N
Small nonadherence
1:20
1:15
Y
Y
Y
340
2084
17
N
N
N
1:00
0:44
1:10
1:25
0:57
A, autologous dermis; H, homologous dermis; I, idiopathic source; L, long finger; OR, operating room; post, postsurgery; pre, presurgery; R,
ring finger; S, small finger; T, traumatic; Th, thumb.
References
1. Cornelius CE 3rd, Shelly WB. Pincer nail syndrome. Arch
Surg 1968;96:321322.